L.G. Voronkov, G.Ye. Dudnik, A.V. Liashenko Renal function in patients with chronic heart failure and reduced left ventricular ejection fraction depending on clinical and hemodynamic parameters

The aim – to examine the relationship between parameters of the renal function and main characteristics in patients with chronic heart failure and reduced left ventricular ejection fraction during their clinical and instrumental examination.

Material and methods. The present analysis includes 134 patients and reduced left ventricular ejection fraction with II–IV New York Heart Association (NYHA) classes. All patients were in stable clinical condition. Baseline measurements included height, weight, blood preasure, heart rate, NYHA classification. All patients were examined by routine ECG, echocardiography. Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. Daily microalbuminuria and urinary albumine/creatinine ratio were determined. Definitions of levels of blood urea nitrogen, uric acid, interleukin-6, NT-proBNP and citrulin were performed. All patients received standard treatment.

Results. The performed study demonstrated the role of GFR as indicator most closely related to the clinical characteristics of the examined patients (NYHA class, age, hypertension, diabetes, anemia) and levels of interleukin-6 and citrulline. Microalbuminuria level and albumin/creatitine ratio in urine did not show a similar relation, except for the NYHA class. Blood urea nitrogen was higher in patients with higher NYHA class and with concomitant diabetes and anemia. All studied parameters of the renal function revealed a reliable association with uric acid level. There were no significant (P<0.05) relationships between renal function parameters and systolic blood pressure, heart rate, left ventricular ejection fraction and flow-dependent vasodilator response of the brachial artery, as well as the level of NT-proBNP in plasma. Conclusions. Among stable patients with chronic heart failure and reduced left ventricular ejection fraction, there were significantly lower levels of GFR in patients with III–IV NYHA classes, in older women (≥ 63 years) and in patients with hypertension, diabetes and anemia. The level of GFR was directly related to the level of circulating biomarkers, such as uric acid, interleukin-6 and citrulline. The levels of microalbuminuria, urinary albumine/creatinine ratio, blood urea nitrogen were significantly higher in patients with ІІІ–ІV NYHA classes.

Full article